System and method for providing analysis of visual function using a mobile device with display

ABSTRACT

A visual function evaluation is performed using a sequence of interactions with a mobile device. A patient user may perform a variety of visual tests using the mobile device. The mobile device transmits the test results to a remote server implementing analysis of the visual function results using network service. The network service receives the test results, processes the results, and provides the processed results to a healthcare provider. The processed results may include trends of the user&#39;s visual function test performance. The healthcare provider, such as a physician, may optimize and administer treatment based on the data. Early detection of changes in visual function can enable the healthcare provider to individualize treatment, helping to prevent vision loss while minimizing visits to the office, discomfort, and expense.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/352,571, filed Apr. 17, 2014, titled “SYSTEM AND METHOD FOR PROVIDINGANALYSIS OF VISUAL FUNCTION USING A MOBILE DEVICE WITH DISPLAY”, nowPublication No. US-2014-0285769-A1, which is a 35 U.S.C. §371application of International Patent Application No. PCT/US2012/060627,filed Oct. 17, 2012, titled “SYSTEM AND METHOD FOR PROVIDING ANALYSIS OFVISUAL FUNCTION USING A MOBILE DEVICE WITH DISPLAY”, now Publication No.WO 2013/059331 A1, which claims the benefit of provisional applicationNo. 61/548,152, filed Oct. 17, 2011, titled “SYSTEM AND METHOD FORPROVIDING ANALYSIS OF VISUAL FUNCTION USING A MOBILE DEVICE WITHDISPLAY”, each of which is incorporated herein by reference in itsentirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

FIELD

The present invention relates generally to a system for analysis ofvisual function of a person using a mobile device with a display andcommunication capability, and method of use thereof. In variousrespects, the invention is directed to a system that allows patients tomonitor their vision using a mobile device, manage treatment andtherapy, and streamline communications between patients, physicians andhealthcare providers.

BACKGROUND

Many different diseases may result in vision loss and even blindness, ifnot promptly recognized and treated. Vision loss associated with retinaldiseases typically involves several important symptoms including imagedistortion, decrease in visual acuity, loss of contrast discrimination,especially in low lighting conditions, holes or defects in the visualfield, or inability to accurately distinguish colors.

Severity of symptoms is typically highly correlated with the stage ofthe disease, and generally, earlier diagnosis and treatment improve thepotential for a good outcome. Important changes in the visual functioncan be quantified by the vision tests, which have been historicallyadministered in the offices of eye physicians and optometrists.

Availability of new tools for the treatment of retinal diseases,particularly a class of compounds called VEGF inhibitors (Lucentis andAvastin) have dramatically improved the therapeutic outcomes. However,every patient is different with respect to the optimum dose andfrequency of these treatments. Without frequent measurements of visionto monitor disease progression some patients may be under-treated, whileothers over-treated. Under-treatment can lead to severe and irreversibledisease progression and associated loss of vision. Over-treatment isexpensive, uncomfortable and potentially increases the risk ofcomplications.

A single test in the doctor's office provides only one snapshot of thevisual function, and may be a subject to random fluctuation of vision.Frequent testing of vision using a variety of tests will allow detectingtrends in the visual function with much higher precision than a singletest can provide. As a result, there is a need in the art for improvedanalysis of visual function.

SUMMARY OF THE DISCLOSURE

Methods are disclosed herein for performing a visual function evaluationof a patient with a retinal disease. The patient can be under recurrenttreatment. The methods include executing a patient administered visualfunction evaluation on a mobile device. The evaluation can include oneor more visual function tests pre-selected by a healthcare provider.Each visual function test can be comprised of a number of steps and thedifficulty of a subsequent step is based on a patient's response to aprevious step within the test. The methods include indicating at leastone response to a pre-selected visual function test using a touch screenon the mobile device.

The one or more tests can be selected by the healthcare provider bydirect communication with the patient or using a remote server with theselection of the one or more tests transmitted to the patient's mobiledevice. The visual function tests can be pre-selected by the healthcareprovider patient based on patient-specific, disease-specific, ortreatment-specific criteria. The visual function tests can bepre-selected by the healthcare provider based on the retinal disease orbased on the recurrent treatment. The recurrent treatment can includemonitoring disease progression, administration of a pharmacologicalagent, a laser treatment, visiting a healthcare provider to determinethe need for further treatment. The recurrent treatment can beadministered by a healthcare provider, including a physician or doctor.

The methods can include transmitting the visual function evaluationresults from the mobile device to a remote server. The methods caninclude analyzing the results of the visual function evaluation usingthe remote server to determine if a next treatment is to be scheduled.The remote server can implement an automated analysis of the results ofthe visual function evaluation to determine trends in the patient'svisual function based on the most recent results and previous data.

Examples of visual function tests include visual acuity, contrastsensitivity, low luminance vision, color vision, perimetry, anddistortion in the visual field. The visual function test can include anadjustable difficulty level. For example, a level of difficulty for asubsequent step can be higher than a level of difficulty for a previousstep when the patient enters a correct response in the previous step.The level of difficulty for the subsequent step can be lower than thelevel of difficulty in the previous step when the patient enters anincorrect response in the previous step. The visual acuity can bemeasured by sequentially displaying fonts of various sizes and offeringa multiple choice of fonts for a matching selection.

Methods are also disclosed herein for performing an analysis of a visualfunction of a user with a retinal disease who is receiving recurrenttreatment from a healthcare provider. The methods include receiving theuser's visual function test data from a remote mobile device applicationand executing a test data analysis module stored in memory by aprocessor. The executed test data analysis module can process the visualfunction test data to generate a trend data of visual function. The dataanalysis module can analyze the trend data of visual function based onthe retinal disease of the user to determine the user's response totreatment, need for treatment, or need for evaluation by a healthcareprovider. The visual function test data and the trend data can betransmitted to a remote computing device.

The methods can include predicting a time for the next treatment for theuser based on the trend data of visual function. The methods can includeanalyzing the trend data of visual function and comparing the trend datato previous trend data for the user. The methods can includetransmitting an alert to the remote computing device if the trend dataof visual function is outside of a range of acceptable variation incomparison to the previous trend data for the user. The methods caninclude making the visual function test data and the trend dataavailable to the healthcare provider.

Systems for performing a visual function analysis are disclosed herein.The systems include a processor, a memory, a test data analysis modulestored in memory and executable by the processor to generate trend datafrom visual function test data received from a remote mobile deviceassociated with a user having a retinal disease and receiving recurrenttreatment from a healthcare provider and an I/O interface module storedin memory and executable by the processor to send trend data and aphysician message to the remote mobile device. The visual function testdata can correspond to tests that were pre-selected for the user by theuser's healthcare provider and performed by the user using the remotemobile device.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1A is a block diagram of an exemplary system to implement a visualfunction analysis system.

FIG. 1B is a flow chart of a method for performing a visual functionevaluation of a patient.

FIG. 1C is a flow chart of a method for performing an analysis of avisual function of a user.

FIG. 2A is a block diagram of an exemplary mobile application.

FIG. 2B is a block diagram of an exemplary server application.

FIG. 3 is a flow chart of a method for performing an analysis of visualfunction of a person using a mobile device.

FIG. 4 is a flow chart of a method for setting-up a user account.

FIG. 5A is a flow chart of a method for administering an initial testset.

FIG. 5B is a flow chart of a method for administering an initial testset on a mobile device.

FIG. 6 is a flow chart of a method for analyzing initial test setresults.

FIG. 7 is a flow chart of a method for configuring subsequent test sets.

FIGS. 8A-8D illustrate screenshots of an interface for configuringmobile application settings.

FIGS. 9A-9D illustrate screenshots of an interface for managingtreatment data.

FIG. 10 illustrates a screenshot of an interface for managingappointment data.

FIGS. 11A-11D illustrate screenshots of an interface for managing testdata.

FIGS. 12A-12D illustrate screenshots of an interface for performing avisual acuity test.

FIGS. 13A-13C illustrate screenshots of an interface for performing aninverse acuity test.

FIGS. 14A-14D illustrate screenshots of an interface for performing acontrast sensitivity test.

FIGS. 15A-15B illustrate screenshots of an interface for performing areverse contrast test.

FIGS. 16A-16C illustrate screenshots of an interface for performing acombination visual acuity and contrast sensitivity test.

FIGS. 17A-17C illustrate screenshots of an interface for performing lowlight sensitivity test.

FIGS. 18A-18D illustrate screenshots of an interface for performing acolor visual acuity test.

FIGS. 19A-19D illustrate screenshots of an interface for performing anAmsler grid test.

FIGS. 20A-20B illustrate screenshots of an interface of a patient userdashboard.

FIG. 21 is a block diagram of an exemplary system for implementing amobile device.

FIG. 22 is a block diagram of an exemplary system for implementing acomputing device.

DETAILED DESCRIPTION

Methods, devices, and systems for evaluating the visual function of userare disclosed herein. The visual function evaluation of the patient caninclude one or more visual function tests. The systems and methods forevaluating visual function can be used with a mobile device with adisplay. The mobile device may electronically communicate with a networkservice, such as a web service, through a combination of cellularnetworks and other networks. A patient user may perform a variety ofvisual tests using the mobile device. The mobile device transmits thetest results to a remote server implementing an analysis networkservice. The network service receives the test results, processes theresults, and provides the processed results to a physician. Theprocessed results may include trends of the user's test performance,variation of various measures of visual function over time (acuity,contrast, color, distortions etc.).

The trend for a visual function test is a patient's performance for thattest over a period of time. The period of time may be an hour, a day, aweek, a month, or any other period of time. Trend data for a visualfunction test may include two or more data points generated by the testat different times by the user. For example, if a user takes a visualacuity test once a month for one year, the trend data will includetwelve data points which can be used to form a trend.

The healthcare provider may optimize and administer treatment based onthe data in a timely manner. Early detection of changes in visualfunction may empower patients and enable their physicians toindividualize treatment, helping to prevent vision loss while minimizingvisits to the office, discomfort and expense. Hence, regular testing mayhelp to identify changes in vision and track them over time. Trackingchanges over time may, in turn, help physicians optimize treatment of apreexisting eye condition or diagnose a new problem earlier.

The trend data for visual function can be useful to the healthcareprovider to improve the effectiveness and timing for patient treatment.The trend data can be used to predict the need for additional treatmentfor the patient. Patients can respond differently to periodictreatments. Analysis of the trend data for the patient can improve theeffectiveness of the treatment by tailoring the timing betweentreatments for the individual patient.

Tailoring the timing of the recurrent treatment can have advantages forboth the healthcare provider and patient. It can be difficult forpatients with ophthalmic problems to arrange travel for appointments.Optimizing the timing for recurrent treatments can reduce theinconvenience for the patient traveling to appointments. Appointmentsfor recurrent treatment are often set at a regular interval. In somecases the patient can have regularly scheduled appointments for arecurrent treatment and not exhibit a decrease in visual function orsymptoms typically treated by the recurrent treatment. The office visitmay not be useful for the patient and also take up additional time ofthe healthcare provider. Moreover, the decrease in visual function orsymptoms in the patient may arise shortly after the appointment andrequire scheduling an appointment on short notice for additionaltreatment. The trend data can allow for tailoring the timing oftreatments for the patient, thereby improving the effectiveness of thetreatment by the healthcare provider and minimizing inefficient use ofthe patient's time and the healthcare provider's time.

Analysis of the trends in the patient's visual function can also provideearly alerts to the healthcare provider and patient of a possible changein the visual function of the patient. The alert can allow for early andpreventative treatment for the patient to prevent additional loss invisual function.

The patient can be under recurrent treatment administered by ahealthcare provider. The healthcare provider can include a doctor,physician, nurse, medical technician, or other medical professional. Insome cases the recurrent treatment is administered by a doctor orphysician.

The recurrent treatment can include any type of treatment from ahealthcare provider. In some embodiments the recurrent treatment caninclude monitoring disease progression in the patient. In someembodiments the recurrent treatment can include administration of apharmacological agent. In some embodiments the recurrent treatment canbe a laser treatment. In some embodiments recurrent treatment caninclude an intraocular injection of a pharmacological agent. Examples ofpharmacological agents include VEGF inhibitors such as Lucentis andAvastin.

In some embodiments recurrent treatment can include visiting aphysician's office and conducting testing under the guidance of ahealthcare provider. The visit to the physician's office can be used todetermine whether the patient has a need for additional treatment. Insome embodiments recurrent treatment can include retinal imaging. Theretinal images can be analyzed to determine the need for furthertreatment.

An evaluation of the visual function of the patient can include one ormore visual function tests. Examples of visual function tests includevisual acuity, contrast sensitivity, low luminance vision, color vision,perimetry, and distortion in the visual field.

The visual function tests can be pre-selected from a list of availablevision tests by the healthcare provider. For example, the physician ordoctor treating the patient can select which of the visual function testor tests stored on the mobile device for the patient to take. The doctorcan select the visual function tests that are relevant for the specificpatient. The healthcare provider can upload the selection to a server.The selection of test or tests can be sent from the server to thepatient's mobile device. The patient can then be automatically directedto take the selected test or tests on their mobile device.

The visual function test or tests can be pre-selected by the healthcareprovider based on a number of factors. The visual function test can beselected by the healthcare provider based on patient specific, diseasespecific, or treatment specific criteria. The visual function test canbe selected based on the patient's retinal disease. The visual functiontest can be selected based on the results of retinal imaging of thepatient. The visual function test can be selected based on the recurrenttreatment that the patient receives. For example, a distortion test canbe selected for a patient with dry macular degeneration disease to testfor progression to a wet macular degeneration disease. A distortion test(metamorphopsia) can be prescribed to monitor development of a diabeticmacular edema.

The frequency of the visual function evaluation can be set by thehealthcare provider. The frequency for individual tests within thevisual function evaluation can also be set by the healthcare provider.The frequency of the testing can be initially set to a default setting.The healthcare provider can change the frequency after reviewing thepatient's responses during a monitoring period or after reviewing trendsin the patient's visual function. The frequency can also be set byanalyzing the trend data for the user.

The methods and systems disclosed herein can be useful for patientshaving a number of retinal disease and ophthalmic disorders. Examples ofretinal disease include macular degeneration, diabetic retinopathy,diabetic macular edema, retinal vein occlusion, glaucoma, and chronicretinal detachment. Examples of macular degeneration include dry maculardegeneration and wet macular degeneration.

The visual function tests can be stored and displayed on the mobiledevice. The patient (user) can input the answers to the tests bytouching a touch screen on the mobile device. The patient can also makean audible response to the tests.

The visual function tests are disclosed in greater detail below. Ingeneral, the visual function tests can have an adjustable difficultylevel based on previous test responses. The difficulty level of the nextstep in the visual function test can be at a lower level of difficultyif the patient incorrectly answers the test question. The difficultylevel of the next step in the visual function test can be at a higherlevel of difficulty if the patient correctly answers the test question.

In some cases the visual function tests can end once a question at aspecified level of difficulty has been reached. In some cases the testcan end after multiple correct responses have been entered at one levelof difficulty with multiple incorrect responses at the next higher levelof difficulty. The progression of test steps and difficulty of the stepscan be adjusted based on the methods and algorithms disclosed herein.

The results of the visual function evaluation and individual tests canbe sent to a remote server for analysis of the data. The remote servercan be used to analyze the visual function test data. The remote servercan implement an automated analysis of the results of the visualfunction evaluation to determine trends in the patient's visual functionbased on the recent results and previous data. The server can analyzethe visual function data to determine if a next treatment is to bescheduled for the patient.

The data analysis of the results of the visual function evaluation caninclude comparing the results to a baseline level of performance for thepatient. The baseline level of performance for the patient can bedetermined from previous visual function evaluation and test results.The server can be configured to send an alert to the healthcare providerif the visual function test results deviate from the baseline level ofperformance above a delta level. The healthcare provider can specify thedelta level.

The analysis by the remote server can include comparing the trends inthe patient's visual function to trends for other patients or groups ofother patients.

In some embodiments the results of the analysis of the patient's visualfunction can be provided to the healthcare provider. The results can beused to help determine whether there is a significant deterioration ofthe visual function that requires any treatment. The results can be madeavailable on a secure webpage. The secure webpage can be accessed by thehealthcare provider and/or user.

In some embodiments the remote server can instruct the mobile deviceapplication to automatically re-test the patient if the visual functionevaluation or test result is outside of a range of acceptable variationfor the patient. The healthcare provider can specify the range ofacceptable variation for the patient. In some cases the remote serveranalysis can analyze the past data for the patient to determine a rangeof acceptable variation for the patient.

In some embodiments the remote server can receive a message from thehealthcare provider for the user and transmit the message to the remotecomputing device.

In some embodiments the analysis performed by the remote server canpredict a time for the next treatment based on the trend in the user'svisual function. The prediction can be transmitted to the remotecomputing device.

FIG. 1A is a block diagram of an exemplary system to implement a visualfunction analysis system. System 100 of FIG. 1 includes mobile device110 and client device 120 associated with user 194, network 150, networkserver 160, application servers 170, and data store 180. The system ofFIG. 1A also includes client 130 for physician or healthcare provider196 and client 140 for third party 198. Though the discussion below mayrefer to a physician, a physician and a healthcare provider are intendedto be interchangeable for the methods and systems disclosed herein.

Mobile device 110 may communicate with network 150 and includes mobileapplication 112. Mobile device 110 may receive input from a user andexecute one or more programs to administer one or more tests to a user,provide test results to application server 170, and receive test setdata, account data, and other data from application server 170. The usermay be a patient of a physician associated client 130. The terms userand patient may be used interchangeably herein. Mobile device 110 isdiscussed in more detail with respect to FIG. 21.

Mobile application 112 resides in memory on mobile device 110 and may beexecuted to allow a user to setup and login to an account with a networkservice, administer test results, and perform other functions. Moredetail for mobile application 112 is discussed with respect to FIG. 2A.

Client device 120 may include network browser 122 and be implemented asa computing device, such as for example a laptop, desktop, workstation,or some other computing device. Network browser 122 may be a clientapplication for viewing content provided by an application server, suchas application server 170 via network server 160 over network 150.

Network 150 may facilitate communication of data between differentservers, devices and machines. The network may be implemented as aprivate network, public network, intranet, the Internet, or acombination of these networks.

Network server 160 is connected to network 150 and may receive andprocess requests received over network 150. Network server 160 may beimplemented as one or more servers implementing a network service. Whennetwork 150 is the Internet, network server 160 may be implemented asone or more web servers.

Application server 170 communicates with network server 160 via networkserver 160 and data store 180. Application server 170 may alsocommunicate with other machines and devices (not illustrated in FIG.1A). Application server 170 may host a server application 172, and othersoftware modules. Application server 170 may be implemented as oneserver as illustrated in FIG. 1A or multiple servers.

Server application 172 may reside on application server 170 and may beexecuted to store, retrieve and transmit test set data, analyze test setresults, and manage alerts. Server application 172 is discussed in moredetail below with respect to FIG. 2B.

Data store 180 may be accessed by application server 170. Data store 170may store data, process data, and return queries received fromapplication server. Data stored on application data store 180 mayinclude user account data, user test data, user test results, analysisof the results such as trend data, and other data.

Clients 130 and 140 and network browsers 132 and 142 may be similar toclient 120 and network browser 122, except that clients 130 and 140 maybe associated with a physician and a third party (such as a drugcompany), respectively, rather than a user (patient).

FIG. 1B is a flow chart of a method 102 for performing a visual functionevaluation of a patient in accordance with one embodiment. The method102 includes executing a patient administered visual function evaluationon a mobile device 103. The visual function evaluation includes one ormore visual function tests pre-selected by a healthcare provider. Eachtest is comprised of a number of steps and the difficulty of asubsequent step is based on a patient's response to a previous stepwithin the test. The method 102 includes indicating at least oneresponse to a pre-selected visual function test using a touch screen onthe mobile device 104. The patient can have a retinal disease and bereceiving a recurrent treatment from a healthcare provider.

The patient administered visual function evaluation on a mobile devicecan include one or more visual function tests pre-selected by ahealthcare provider. The one or more tests can be selected by thehealthcare provider using a remote server with the selection of the oneor more tests transmitted to the patient's mobile device. The visualfunction tests can be pre-selected by the healthcare provider patientbased on patient-specific, disease-specific, or treatment-specificcriteria. The visual function tests can be pre-selected by thehealthcare provider patient based on the retinal disease or based on therecurrent treatment. The recurrent treatment can include monitoringdisease progression, administration of a pharmacological agent, visitinghealthcare provider to determine the need for further treatment. Therecurrent treatment can be administered by a healthcare provider,including a physician or doctor.

The methods can include transmitting the visual function evaluationresults from the mobile device to a remote server. The methods caninclude analyzing the results of the visual function evaluation usingthe remote server to determine if a next treatment is to be scheduled.The remote server can implement an automated analysis of the results ofthe visual function evaluation to determine trends in the patient'svisual function based on the most recent results and previous data.

Examples of visual function tests include visual acuity, contrastsensitivity, low luminance vision, color vision, perimetry, anddistortion in the visual field. The visual functions test can include anadjustable difficulty level. For example, a level of difficulty for asubsequent step can be higher than a level of difficulty for a previousstep when the patient enters a correct response in the previous step.The level of difficulty for the subsequent step can be lower than thelevel of difficulty in the previous step when the patient enters anincorrect response in the previous step. The visual acuity can bemeasured by sequentially displaying fonts of various sizes and offeringa multiple choice of fonts for a matching selection.

FIG. 1C is a flow chart of a method 106 for performing an analysis of avisual function of a user in accordance with one embodiment. The usercan have a retinal disease and be receiving recurrent treatment from ahealthcare provider. The method 106 includes receiving the user's visualfunction test data from a remote mobile device application 107. Themethod 106 includes executing a test data analysis module stored inmemory by a processor, the executed test data analysis module processingthe visual function test data to generate a trend data of visualfunction and analyzing the trend data of visual function based on theretinal disease of the user to determine the user's response totreatment, need for treatment, or need for evaluation by a healthcareprovider 108. The method 106 includes transmitting the visual functiontest data and the trend data to a remote computing device 109.

FIG. 2A is a block diagram of an exemplary mobile application. Mobileapplication 112 may include a test manager module, test administratormodule, account manager module, and a test data storage module. Each ofmodules 210-240 may be stored in memory on mobile device 110 andexecuted by a processor (see FIG. 21). The test manager module mayconfigure test sets to be administered to a user. The test managermodule may select tests to administer and configure each test asrequired or optional. The test set may be configured by the test managermodule based on user input, instructions or other data provided by aphysician, user settings and biographical data, and other data. In someembodiments the test set is selected by the physician for the specificpatient. The pre-selected tests can be automatically administered whenthe mobile application is opened without the need for the patient/userto select the pre-selected tests from the list of all of the testsavailable on the mobile application.

The visual function test can be selected by the healthcare providerbased on patient specific, disease specific, or treatment specificcriteria. The visual function test can be selected based on thepatient's retinal disease. The visual function test can be selectedbased on the results of retinal imaging of the patient. The visualfunction test can be selected based on the recurrent treatment that thepatient receives.

Test administrator module 220 may administer one or more tests to a userthrough the mobile device 110. The tests may be administered as a set oftests. Each test in the test set may be administered by testadministrator module 220 by graphic interfaces provided through adisplay system in the mobile device, as well as audio and other featuresof the mobile device.

Account manager module 230 may manage account data, account login, andother data for a user. The account manager module 230 may store localuser account data, such as account identification, login credentials,user biographical information, and other data. Account manager module230 may perform login with a network service on behalf of a user.

Test data storage 240 may store test data and other data on mobiledevice 110. The test data may include past test results, the test toadminister to a user as part of a test set visual function evaluation,and other test data.

FIG. 2B is a block diagram of an exemplary server application. Serverapplication 172 resides on application server 170 and may include testdata analysis module 250, account data manager module 260, alert managermodule 270, and I/O Interface module 280. Each module may be stored inmemory on application server 170 and executed by one or more processorson application server 170 (see FIG. 22). Test data analysis module 250may be executed to analyze test data results. The test data results canbe received from a remote mobile device associated with a user with aretinal disease. The test data can include results for a user receivingrecurrent treatment from a healthcare provider. The visual functiontests can be pre-selected by the healthcare provider for the user, withthe pre-selected tests sent to the user's remote mobile device.

Analysis of test data results may include identifying long-term trendsin test result data and identifying whether the trend represents anundesirable condition or requires further investigation. Account datamanager module 260 may be executed to manage user account data,including update user account information stored on the applicationserver. Alert manager module 270 may be executed on application server170 to create, configure, modify and process alerts. For example, alertmanager module 270 may be configured to generate an alert message to aphysician if a user (patient) long-term trend data matches a profile fora particular eye disease or disorder. I/O Interface module 280 mayhandle receipt and transmittal of data to and from mobile device 110 andclient device 130, as well as communication between server application170 and other devices and applications.

The test data analysis module can analyze the test data to determinetrends in the user's data. The data analysis can include comparing therecent test data for the user to past results. The past results can befrom anytime in the past, for example the past day, week, month, oryear.

The trends in the user data can be compared to trends for other users ortrend data grouped together for other users. For example, the trends inthe user data can be compared to trend data for other users with similarretinal diseases.

The data analysis can include determining a baseline level ofperformance for the user based on the user's previous test data. Thehealthcare provider can specify a delta level for the user. The dataanalysis can include analyzing the difference between recent test dataand the user's baseline level of performance. If the difference betweenthe recent test data and the baseline is above the specified delta thenan alert can be sent to the user and the healthcare provider.

In some embodiments the baseline for the user can include the averagetest results for the user between recurrent treatments, such as anintraocular injection. The user's vision between the injections can beused to develop the baseline. An alert can be sent to the user andpatient if the test data deviates from the baseline, which couldindicate a problem with the user's vision that could require evaluationby the healthcare provider or a treatment like an intraocular injection.

In some embodiments, the test data analysis can be used to predict thetime for the next treatment. For example, the test data can be analyzedand compared to previous data for the patient to determine an estimatefor the next intraocular injection for the user.

The data analysis can include determining an acceptable level ofvariation for the user. The level of variation can also be set by thehealthcare provider. An automatic retest can be sent to the user fortest data that exceeds the acceptable level of variation. The user canthen retake the visual function test.

The modules of mobile application 112 and server application 172 areexemplary. Mobile application 112 and server application 172 may eachcontain additional or fewer modules and each module may contain one ormore sub-modules or be combined with one or more other modules.

FIG. 3 is a flow chart of a method for performing analysis of visualfunction of a person using a mobile device. A user account is setup fora user (patient) at step 310. The user account may be set-up from eithermobile device 110 or client device 120. Setting up a user account mayinclude performing login, creating a new account, and entering accountdata. More detail for setting-up a user account is discussed below withrespect to FIG. 4.

An initial test set can be configured based on the account set-up atstep 320. The initial test set includes the list of tests to administerto the patient. The initial test set may be set by a physician afterviewing the user account data, selected by the user, or automaticallyconfigured for the user. In various embodiments, the initial test may beautomatically configured based on the patient's biographical data,diagnosis, or other disease characteristics.

The initial test set is administered to the user at step 330. The testsof the initial test set may be administered through mobile device 110 bytest administrator 220. The tests administered to the user may includevisual acuity, inverse acuity, contrast, inverse contrast, combinationof acuity and contrast, low light conditions, color, low light contrast,low light acuity, perimetry, distortion in the visual field, lowluminance vision, Amsler grid, and other tests. Administering tests isdescribed in more detail below with respect to FIGS. 5A-B. Informationregarding tests which can be administered to a user is described in moredetail below with respect to FIGS. 12-19.

Initial test set results are analyzed at step 340. The analysis mayinclude calculating a trend and determining if the trend is associatedwith or suggests a stable condition, the possibility of an undesirablecondition, or improvement. The results of the analysis may be used bythe user (patient) or the physician to monitor the user's visualfunction as a state of a user's current vision-related disease. Invarious embodiments, a user may monitor analysis results using themobile application. In various embodiments, the analysis of the test setresults may be performed by server application 172. Analyzing initialtest results is discussed in more detail below with respect to FIG. 6.

A subsequent test set is configured for the patient at step 350. Thesubsequent test set may be configured based on results from a prioradministered test set, physician recommendations, and user preferences.Configuring a subsequent test set may also include configuring anappointment for the user, prescribing a treatment, and dose reminders.Configuring a subsequent test set is described in more detail below withrespect to FIG. 7.

FIG. 4 is a flow chart of a method for setting-up a user account. Themethod of FIG. 4 provides more detail for step 310 of the method of FIG.3 and may be performed at either mobile device 110, client 120, or acombination of these. A mobile application may be installed on mobiledevice 110 at step 410. The mobile application may be downloaded viacable or wirelessly to the mobile device, installed by a manufacturer,or installed in some other manner. A user login may be performed at step420. At the first login for the user, login credentials may be createdfor the user. Upon subsequent logins, the user login information is usedto log the user into the network service. Typically, a login includes ausername and a password for the user.

Personal information may be received from the user at step 430. Thepersonal information may include user address, phone, email, sex, age,health data, diagnosis data, treatment data and other data. The personalinformation may be received initially, gradually over time, and/orchanged by a user.

A physician selection may be received at step 440. In some cases theuser can select a physician to review his or her test set results andother medical data. By selecting a physician, the user grants thephysician permission to access the user's account with the visualanalysis service. The personal information and physician selection datamay be stored locally, at either the mobile device 110 or client 120, atstep 450. The personal information and physician selection data may betransmitted to data store 180 via network 150, network server 160, andapplication server 170 at step 460.

The physician selection or pre-selected tests can be made by thehealthcare provider, including the physician, doctor, nurse, medicalprofessional, or medical technician. In some cases the physicianselection can be selected by the doctor or physician and entered intothe system by a medical professional, medical technician, or nurse. Thepre-selected tests can be selected by the healthcare provider using aremote server with the selection transmitted to the patient's mobiledevice. The physician selection can be based on any of the patientcriteria disclosed herein.

FIG. 5A is a flow chart of a method for administering an initial testset. The method of FIG. 5A provides more detail for step 330 of themethod of FIG. 2 and may be performed by mobile application 112. Aninitial test set is configured for a user at step 510. The initial testset may be configured based on user input, user stored data (includingage, sex, previous test results and past diagnosis data), physicianinput, and other data. The initial test set may include tests requiredto be taken by the user and optional for the user.

The initial test set is administered to the user on the mobile device110 at step 520. The tests may be administered via one or moreinterfaces provided through the mobile device 110. Exemplary tests toadminister to the user are discussed below with respect to FIGS. 12-19.

Test results from the administered test set are recorded locally at themobile device at step 530. The test results may be used to configuresubsequent tests in the test set and to provide information for aphysician to analyze trends and other information. The test results arethen transmitted to data store 180 via network 150, network server 160,application server 170 and data store 180. Data store 180 receives thetest results and stores the data results as part of the account dataassociated with the user who was tested.

FIG. 5B is a flow chart of a method for administering an initial testset on a mobile device. The method of FIG. 5B provides more detail forstep 520 of the method of FIG. 5A and may be performed by mobileapplication 112. A first test is administered to a user at step 550. Forexample, the first test may be a visual acuity test. A first test may beadministered based on a series of difficulty levels. Each difficultylevel may be tested through an interface more than once. In variousembodiments, a determination is made at step 560 as to whether theresults from the first test satisfy a first performance threshold. Thefirst performance threshold may be set by the physician. If the testresults satisfy a first performance threshold, the test ends. If thetest results do not satisfy a first performance threshold, a second testmay be administered to the user.

In various embodiments, no determination occurs at step 560. Afteradministering a first test to a user at step 550, a second test isadministered to the user at step 570. The second test may be set at adifficulty level based on the responses, score, level of difficulty, orother parameter from the first test. For example, the difficulty levelof the second test may be initially set to the difficulty level in thefirst test at which two or more correct answers were received.

A second test is administered to the user at step 570. For example, thesecond test may be a contrast sensitivity test or a color visual acuitytest. A determination is made at step 580 as to whether the results fromthe second test satisfy a second performance threshold. The secondperformance threshold also may be set by the physician. If the testresults satisfy a second performance threshold, the test ends. If thetest results do not satisfy a second performance threshold, an alert maybe generated at step 590. The alert may be generated for the physicianor the user. The alert may include the test result or a recommendedaction.

The tests administered in a test set may depend on performance inprevious tests within the test set. For example, the second test may beadministered if user performance in the first test does not satisfy aperformance threshold.

In various embodiments, performance in a prior test affects aconfiguration of a subsequent test. The level of difficulty or otherfeatures of the second test may be determined by the results of thefirst test. For example, the contrast sensitivity test may beadministered using fonts sized just above the minimum size that a personcould reliably detect in the test of visual acuity. In variousembodiments, the setting for a test, such as a level of contrast,sensitivity, font size and screen brightness, may be selected to beginthe test at a level close to the typical levels characteristic to thecurrent user. The current user's typical level may be based on previoustest performance such as the score from a previous test. This helps todecrease the number of steps necessary to finish the test. Informationabout the starting point of the test may be extracted from the previousresults and analyzed on the mobile device or on a server.

Although the test set or evaluation discussed with reference to FIG. 5Bincluded two tests, a test set may include any number of visual tests.In various embodiments, the test set may be a standard battery of testsadministered to all users. In various embodiments, the test set may be adynamic battery of tests configured for a particular user. In someembodiments a single visual function test is administered.

FIG. 6 is a flow chart of a method for analyzing initial test setresults. The method of FIG. 6 provides more detail for step 340 and maybe performed by server application 172. Test data is prepared for reviewat step 610. In some embodiments, test results for a user over time areanalyzed for trends. Trends may be identified as normal, improving or acause for concern. Preparing the test data may include identifyingtrends and determining if the trends indicate anything that should be ofconcern.

A physician may login to the network service at step 620. Login for aphysician may be similar to user login at step 420 of FIG. 4, exceptthat the physician may login from computer device 130 and may enterphysician account information rather than user account information.Physician account information may include business information, alertconfiguration data, and other data.

Test data is provided to the physician for review at step 630. Thephysician may review the prepared test data at computer 130. Reviewingtest data may include viewing trends of test data, determining whetherprevious treatments have been successful, and identifying any areas ofconcern for the user (patient) based on the test data. The results ofthe analysis may be used by the physician to monitor the user's visualfunction as a state of a user's current vision-related disease.

Physician input regarding the user tests may be received at step 640.The physician input may be used to reconfigure the test set. The testset may be reconfigured to adjust, add, and remove tests from a test setfor the user in view of the trends, treatment response, and areas ofconcern. Physician input regarding the user account may be received atstep 650. The user account input may include a message to the userregarding one or more tests, a request for the user to make anappointment, and adding, deleting, or changing a prescription, or otheraccount information addition, deletion or change. The updated test setand user account data may be stored at data store 180 at step 660.

Alert configuration information may be received from a physician at step670. The alert configuration information may specify what alerts to setfor each user the physician is working with, how the alert is triggered,and an action to take upon each alert. For example, for a particularuser, a physician may configure an alert to be triggered upon detectingthat the user's vision has degenerated by two or three lines of visualacuity, or a certain percentage of contrast sensitivity in a recentmonth or other defined period of time. The physician may set the alertaction to show up next to patient's name in on the doctor's list ofpatients, or as an email to the physician. Physician and patient canalso be alerted if the patient did not take tests for a certain periodof time, or if he missed a scheduled appointment.

FIG. 7 is a flow chart of a method for configuring subsequent test sets.A subsequent test set is configured for a set of users at step 710. Thesubsequent test set may be configured by the test manager module onmobile application 112. The subsequent test set may be administered tothe user at step 720. Test administrator module on mobile application112 may administer the application to the user through mobile device112.

Test results from the administered test set are stored locally on mobiledevice 112 at step 730. The test results may be transmitted to datastore 180 at step 740. Data updated by a physician is provided to a userat step 750. The updated data may include changes in accountinformation, such as a physician message regarding a previous test, arequest for an appointment, or other information.

The steps of the methods for FIGS. 3-7 are in an exemplary order and notintended to be limiting. The methods of FIGS. 3-7 may be performed atleast in part by mobile application 112 and server application 172, aswell as by client computers 120-140 used by a user, a physician and athird party.

FIGS. 8A-8D illustrate screenshots of an interface for configuringmobile application settings. FIG. 8A illustrates an initial screen fortaking tests and joining or logging into the visual function analysisnetwork service. The interface of FIG. 8A receives input selecting anacuity test, more tests, more information, or user login. The interfaceof FIG. 8B illustrates an interface for receiving settings forparticular tests. The interface of FIG. 8B is an interface that receivesinput for setting each of an inverse contrast, a combination visualacuity and contrast sensitivity test, and low light test on and off, aswell as units for test results. FIG. 8C is an interface that alsoprovides settings for individual tests. In particular, the interface ofFIG. 8C provides settings for acuity, inverse acuity, color acuity,contrast, inverse contrast, a combination visual acuity and contrastsensitivity test, and low light test. FIG. 8D is an interface that alsoallows a user to configure settings for different tests, as well asreceiving input for a user to sign-out. FIGS. 8B-8D may be part of thesame interface which is accessible by scrolling up and down.

FIGS. 9A-9D illustrate screenshots of an interface for managingtreatment data. FIG. 9A is an interface that receives a user selectionof a treatment type that the user has received in the past. For example,the treatment type may include, but is not limited to, Avastin,Lucentis, Triamcinolone, Ozurdex, VEGF-TRAP, Visudyne, laser or surgery.The interface of FIG. 9B receives eye treatment data from a user. Theinterface of FIG. 9C allows a user to specify a date and time of ascheduled appointment. The interface of FIG. 9D allows a user to specifya date and time of an eye treatment received. Icons at the bottom of theinterface screen correspond to the following in the interfaces of themobile application: E corresponds to a test interface, the Graph iconcorresponds to a results interface, Rx corresponds to a treatmentinterface, the Calendar icon corresponds to an appointment schedulinginterface, the star icon corresponds to the Settings interface.

FIG. 10 illustrates a screenshot of an interface for managingappointment data. The interface of FIG. 10 allows a user to edit and addappointments related to visual testing and treatments, for example witha physician.

FIGS. 11A-11D illustrate screenshots of an interface for managing testdata. FIG. 11A illustrates an interface for managing tests for a user.The interface of FIG. 11A allows a user to select a particular test tobe edited or configured from a test menu. The interface of FIG. 11Bprovides additional tests to be edited by a user, and may be part of thesame interface illustrated in FIG. 11A. The interface of FIG. 11B alsoillustrates a “My Test Sequence” which, when selected, providesinformation for the user's test sequence which can be edited. In variousembodiments, the “My Test Sequence” may include a test set selected bythe physician.

FIG. 11C provides information for each test taken by a user. Forexample, the interface of FIG. 11C indicates that a user last took anacuity test on Sep. 22, 2011, but has never taken an inverse contrasttest. FIG. 11D provides more detail for an acuity test. The additionalinformation for the acuity test may include previous test dates andresults for the user's right eye and left eye.

The visual function evaluation can include a visual acuity test. Table 1illustrates visual acuity levels for different standards. The visualacuity test can begin with a letter size in the middle of the range, forexample 20/70, and decreases by one step or level after each correctresponse. The test difficulty can increase by one step or level after anincorrect response. The visual acuity test can stop at a level where twoor more correct responses have been obtained and with two or moreincorrect responses obtained at a level one level harder than the levelwhere the correct responses were obtained. The test can also end whenthe minimum font size (e.g. 20/20) has been identified correctly two ormore times or the maximum font size (e.g. 20/400) has not been answeredcorrectly two or more times. In the latter case the result is ≦20/400.

TABLE 1 Visual acuity levels ETDRS English Metric Decimal LogMAR Letters 20/400  6/120 0.05 1.30 20  20/200 6/60 0.10 1.00 35  20/100 6/30 0.200.70 50 20/70 6/21 0.29 0.54 58 20/60 6/18 0.33 0.48 61 20/50 6/15 0.400.40 65 20/40 2/12 0.50 0.30 70 20/30 6/9  0.67 0.18 76 20/25  6/7.50.80 0.10 80 20/20 6/6  1.00 0.00 85

FIGS. 12A-12D illustrate screenshots of an interface for performing avisual acuity test. The user interface of FIG. 12A provides a user withinstructions before beginning a portion of the visual acuity test forthe right eye. The user interface of FIG. 12B provides a user with atest symbol of a particular size and a list of symbols to choose from.The test interface allows a user to select a symbol that the userbelieves matches the test symbol. Within the interface of FIG. 12B, aletter appears in the test field, and six choices of the letters areshown below it. There is also a button at the bottom “can't see.” Duringthe test, the patient provides input to select (e.g., by selection on atouch screen) one of the six letters displayed in the panel below thetest window that corresponds to the one displayed in the test field. Ifthe patient touches the correct letter, the next letter will appearsmaller. FIG. 12C provides an interface that displays a smaller testsymbol and a set of choices for the user to select a symbol whichmatches the test symbol. If the response is incorrect, or the patientselects the “can't see” button, the letter in the test field becomeslarger. The test can end when the patient correctly identifies thesmallest font (e.g. 20/20 acuity) or enters a specified number ofincorrect responses at a certain level. The healthcare provider canspecify the number of incorrect responses. In some embodiments thespecified number of incorrect responses is two. In some embodiments thespecified number of incorrect responses can be set at three, four, orany higher integer. After the first incorrect answer, the letter becomeslarger, if the response indicates correct identification, the letterbecomes smaller again. If another incorrect response is determined againat that level, the test ends, and visual acuity will be the lowest levelwhich was correctly identified twice. Alternative choice lettersrandomly change for every test letter. Letter size is adjustedautomatically based on success of the responses, and the result isstored upon completion of the test. FIGS. 13A-13C illustrate screenshotsof an interface for performing an inverse acuity test. This test issimilar to the visual acuity test only a white letter is displayed onblack background of the test window. As the test progresses, the size ofthe dark letter decreases against a white background, i.e. the testletter becomes progressively smaller. Similar to the visual acuity test,alternative choice letters are randomly changed for every test letter.The letter size may be adjusted automatically based on the success ofthe responses. The interface of FIG. 13A provides a larger symbol withsix symbols for the user to select as a matching symbol, FIG. 13Bprovides a smaller symbol with six potential matching symbols forselection, and FIG. 13C provides results for the inverse acuity test andinstructions for performing the next test.

A low light acuity test can be administered to the patient. For the lowlight visual acuity test, the interface may initially provide a blackletter on a lighter background. In this case the visual acuity ismeasured first at high contrast. The brightness of the background canthen be decreased to 25% and acuity is measured again, starting 2 linesor levels above the acuity level measured at high contrast.

The visual function evaluation can include a contrast sensitivity test.Contrast of the letters in the contrast sensitivity test can be variedaccording to the Peli-Robson Contrast scale with each step in thecontrast sensitivity test. For example, the level of black in the greycan be decreased by approximately √{square root over (2)} for eachsuccessive step. The level of black in the grey can be digitizedaccording to the LCD screen brightness levels. Therefore the contrast Cafter N successive steps is calculated as following: =100*2^(1-n/2)(%).The contrast in this test ranges from 100%, which corresponds to blackletters on a white background to 1.1%, which corresponds to very faintgrey letters on white background. For example, the calculated contrastfor successive steps could be 100%, 70.7%, 50%, 35.4%, 25%, 17.7%,12.5%, 8.8%, 6.3%, 4.4%, 3.1%, 2.2%, 1.6%, and 1.1%.

The contrast sensitivity test can be configured to begin at a contrastlevel in the middle of the contrast range, for example at about 25%contrast. The contrast can decrease after each correct response orincreases after an incorrect response. The test can end at the levelwhere two or more correct responses have been obtained with two or moreincorrect responses obtained at one level harder. Alternatively, thetest can end when the minimum contrast (e.g. about 1.1%, has beenidentified correctly two or more times or the maximum contrast (100%)has not been identified correctly two or more times.

FIGS. 14A-14D illustrate screenshots of an interface for performing acontrast sensitivity test. In the contrast sensitivity test, the symbolsbecome progressively lighter in comparison with the background. Theinterface of FIG. 14A provides an “F” with a first contrast level alongwith six potentially matching letter options and a “can't see” button.The interface of FIG. 14B provides a “P” at second contrast level (alower contrast level) in the test window along with the six potentiallymatching letter options and a “can't see” button. The interface of FIG.14C provides an “X” at a third contrast level (lower than the secondcontrast level) in the test window along with the six potentiallymatching letter options and a “can't see” button. If the patient selectsthe correct letter, the contrast decreases. If the patient has anincorrect response or selects the “can't see” button, the contrast willincrease. The test ends when a patient has an incorrect response at acertain level of contrast two or more times. FIG. 14C illustrates aninterface which provides contrast sensitivity test results to the user.FIGS. 15A-15B illustrate screenshots of an interface for performing aninverse contrast test. The inverse contrast test is similar to thecontrast sensitivity test provided through the interfaces of FIGS.14A-14D, except the test letter is light and the background of the testwindow is black. During the test, the test letter becomes progressivelydarker. If the response is correct, the test letter darkens. If theresponse is incorrect, or the patient selects the “can't see” button,the test letter becomes lighter. The test ends when the patient eithercorrectly identifies the darkest letter, or has an incorrect response ata certain level two or more times. The interface of FIG. 15A provides a“K” against a black background along with six potentially matchingletter options and a “can't see” button. FIG. 15B illustrates aninterface which provides inverse contrast sensitivity test results tothe user.

FIGS. 16A-16C illustrates screenshots of an interface for performing acombination visual acuity and contrast sensitivity test. The test beginswith a standard test of visual acuity performed with a black letter onwhite background. After the patient reaches a minimum level, the fontsize increases by at least one font size number. In various embodiments,the physician selects the appropriate number of sizes to increase thefont size and may include one or two font sizes. After the level ofacuity is determined from the visual acuity test, the contrast of theletter may start decreasing. The contrast sensitivity test is performedas described with respect to the interfaces of FIGS. 14A-14D. The testends when the patient either correctly identifies the darkest letter, orhas an incorrect response at a certain level twice. This test ofcontrast sensitivity is more challenging than the same test with largeletters, and it is tailored to challenge the patient at their level ofvisual acuity. As indicated, FIGS. 16A-16B provide interfaces whichdisplay letters against a white background. FIG. 16C provides resultsfor the combination test as well as instructions to perform the nexttest.

FIGS. 17A-17C illustrate screenshots of an interface for performing lowlight sensitivity test. The low light test mimics the situation with lowlighting in a room. For the low light sensitivity test, the interfacemay initially provide a black letter on white background. The backgroundof the test window gets darker with each correct response, and lighterif the patient selects the “can't see” button or with each incorrectresponse. The test ends when the patient either correctly identifies theletter with the darkest background, or has an incorrect response at acertain level twice. Alternative choice letters may randomly change forevery test letter as in the interfaces for the visual acuity test ofFIGS. 12A-12D. FIGS. 17A-17B illustrate interfaces having black lettersand progressively darker backgrounds, along with a selection of sixpotential matching letters and a “can't see” button. The interface ofFIG. 17C provides results to a user and instructions for the next test.The contrast sensitivity test can begin at a desired contrast level. Forexample, a background level of 50% of white can be used for the firststep.

FIGS. 18A-18D illustrate screenshots of an interface for performing acolor visual acuity test. The color visual acuity test measures visualacuity with different colored fonts. For example, blue colored fonts maybe used for the first part of the test and red colored fonts may be usedfor the second part of the test. The color of the font may include blue,red, green, yellow or any other color. FIGS. 18A and 18B display alarger blue “S” and red “Z”, respectively, along with a selection of sixpotential matching letter options and a “can't see” button. FIG. 18Cdisplays a smaller letter “F” in blue along with a selection of sixpotential matching letters and a “can't see” button. The color acuitytest is performed in a similar manner as the visual acuity test asdescribed with respect to the interfaces of FIGS. 12A-12D. The interfaceof FIG. 18D provides results to a user and instructions to perform thenext test. Discrepancy between these tests is indicative of eitherretinal disease or cataract.

FIGS. 19A-19D illustrate screenshots of an interface for performing anAmsler grid test. The Amsler grid test shows a grid of lines through aninterface. The patient is provided an interface with a fixation point inthe center of the grid (red point) and prompted to mark the areas thatappear distorted. The interface then receives user (patient) input inthe areas of image distortion. For example, with a touch screeninterface, the patient may touch the screen in the areas where the gridappears distorted. The image distortion may include a reduced contrast,curved lines, and/or missing part of the image. Similar to previoustests described, a correct response increases the level of difficultyand an incorrect response or selection of the “can't see” buttondecreases the level of difficulty. The test ends when a patient respondsincorrectly twice at a certain level. The Amsler grid test detects imagedistortion and small variations in retinal sensitivity. It may be usefulin identifying the earliest symptoms of macular disease. FIG. 19Aincludes an interface which provides instructions for the user to beginthe Amsler grid test. FIGS. 19B-19C provide an interface having a gridof lines with shaded portions to be selected by a user. FIG. 19Dprovides an interface which displays the results of the Amsler grid testfor an eye and prompts the user to continue with the Amsler test for aright eye. Areas marked by the patient through an interface provided bythe mobile application may then be quantified in terms of the totalsurface area and location relative to the fixation center. Thequantifying may be performed by the mobile application or remotely by aserver application. Distortion can be indicative of a transition fromdry macular degeneration disease to wet macular degeneration disease.

The exemplary visual function tests described above with respect toFIGS. 12-19 are not intended to be limiting. In various embodiments, avisual function test includes a test object, letter or shape. The visualfunction test may vary the test object, letter or shape in anycombination including color, contrast (field) or brightness(light/dark). The background of the test window may also vary in anycombination of color, contrast (field) or brightness (light/dark). Thevisual function tests may also be dynamic, such as responding to flasheson the screen (mapping of visual field sensitivity), moving text orchanging text (reading speed). The visual function tests may alsoinclude “undoing” the distortion in the field by shifting lines to makethem appear straight. Generally speaking, correct responses increase thelevel of difficulty and incorrect responses decrease the level ofdifficulty. A visual function test may end when the user errs twice at acertain level of difficulty and provides a correct answer twice at theprevious level. Other integers can be used for the number of correct andincorrect responses.

FIGS. 20A-20B illustrate screenshots of an interface of a patient userdashboard. FIG. 20A provides an interface dashboard having informationfor a user's account with the visual test and analysis service. Thedashboard presents data such as the most recent self-test visualfunction test, the last office visit data, and test and treatment datawhich may be presented in either table or graph format. Within the userdashboard, a user may select to view their home page (“My Sightbook”),account settings page, My Information page, and request to connect withthe user's physician.

Within FIG. 20A, the user can select to view trend data for a particulartest. The trend data may be presented in a table format or as agraphical representation. The interface of FIG. 20B provides a graphicalrepresentation of trend data for a visual acuity test for the user'sright eye. The trend data plots the user test scores for the test over aperiod from February 1 to August 1 within a year. The test data and timeperiod may vary based on user input and available data. In variousembodiments, the trend data plot my also include when a treatment isreceived. For example, an “L” indicates when the user (patient) wasadministered a treatment of Lucentis. The trend data varies for eachindividual. For example, a first user (patient) may require apharmacological treatment every four to six weeks while a second user(patient) may require the same pharmacological treatment every six toeight weeks. Monitoring the trend data of each individual user may allowthe physician to personalize and manage treatment for each user. Inaddition, the trend data may better predict when the user is in need ofa treatment.

FIG. 21 illustrates an exemplary mobile device system 2100 that may beused to implement a mobile device for use with the present technology,such as for mobile device 212. The mobile device 2100 of FIG. 21includes one or more processors 2110 and memory 2112. Memory 2112stores, in part, programs, instructions and data for execution andprocessing by processor 2110. The system 2100 of FIG. 21 furtherincludes storage 2114, one or more antennas 2116, a display system 2118,inputs 2120, one or more microphones 2122, and one or more speakers2124.

The components shown in FIG. 21 are depicted as being connected via asingle bus 2126. However, the components 2110-2124 may be connectedthrough one or more data transport means. For example, processor unit2110 and main memory 2112 may be connected via a local microprocessorbus, and storage 2114, display system 2118, input 2120, and microphone2122 and speaker 2124 may be connected via one or more input/output(I/O) buses.

Memory 2112 may include local memory such as RAM and ROM, portablememory in the form of an insertable memory card or other attachment(e.g., via universal serial bus), a magnetic disk drive or an opticaldisk drive, a form of FLASH or PROM memory, or other electronic storagemedium. Memory 2112 can store the system software for implementingembodiments of the present invention for purposes of loading thatsoftware into main memory 2110.

Antenna 2116 may include one or more antennas for communicatingwirelessly with another device. Antenna 2116 may be used, for example,to communicate wirelessly via Wi-Fi, Bluetooth, with a cellular network,or with other wireless protocols and systems. The one or more antennasmay be controlled by a processor 2110, which may include a controller,to transmit and receive wireless signals. For example, processor 2110execute programs stored in memory 2112 to control antenna 2116 transmita wireless signal to a cellular network and receive a wireless signalfrom a cellular network.

Display system 2118 may include a liquid crystal display (LCD), a touchscreen display, or other suitable display device. Display system 2118may be controlled to display textual and graphical information andoutput to text and graphics through a display device. When implementedwith a touch screen display, the display system may receive input andtransmit the input to processor 2110 and memory 2112.

Input devices 2120 provide a portion of a user interface. Input devices2160 may include an alpha-numeric keypad, such as a keyboard, forinputting alpha-numeric and other information, buttons or switches, atrackball, stylus, or cursor direction keys.

Microphone 2122 may include one or more microphone devices whichtransmit captured acoustic signals to processor 2110 and memory 2112.The acoustic signals may be processed to transmit over a network viaantenna 2116. Microphone 2122 may receive acoustic signals that can beanalyzed by voice recognition software to identify user commands. Theuser commands can be processed as input to perform different tasks andcontrol the mobile application instead of a touchscreen.

Speaker 2124 may provide an audio output for mobile device 2100. Forexample, a signal received at antenna 2116 may be processed by a programstored in memory 2112 and executed by processor 2110. The output of theexecuted program may be provided to speaker 2124 which provides audio.Additionally, processor 2110 may generate an audio signal, for examplean audible alert, and output the audible alert through speaker 2124.

The mobile device system 2100 as shown in FIG. 21 may include devicesand components in addition to those illustrated in FIG. 21. For example,mobile device system 2100 may include an additional network interfacesuch as a universal serial bus (USB) port.

The components contained in the computer system 2100 of FIG. 21 arethose typically found in mobile device systems that may be suitable foruse with embodiments of the present invention and are intended torepresent a broad category of such mobile device components that arewell known in the art. Thus, the computer system 2100 of FIG. 21 can bea cellular phone, smart phone, hand held computing device, minicomputer,or any other computing device. The mobile device can also includedifferent bus configurations, networked platforms, multi-processorplatforms, etc. Various operating systems can be used including Unix,Linux, Windows, Macintosh OS, Google OS, Palm OS, and other suitableoperating systems.

FIG. 22 illustrates an exemplary computing system 2200 that may be usedto implement a computing device for use with the present technology.System 2200 of FIG. 22 may be implemented in the contexts of the likesnetwork server 160, application server 170, data store 180, and clientdevices 120-140. The computing system 2200 of FIG. 22 includes one ormore processors 2210 and memory 2220. Main memory 2220 stores, in part,instructions and data for execution by processor 2210. Main memory 2220can store the executable code when in operation. The system 2200 of FIG.22 further includes a mass storage device 2230, portable storage mediumdrive(s) 2240, output devices 2250, user input devices 2260, a graphicsdisplay 2270, and peripheral devices 2280.

The components shown in FIG. 22 are depicted as being connected via asingle bus 2290. However, the components may be connected through one ormore data transport means. For example, processor unit 2210 and mainmemory 2220 may be connected via a local microprocessor bus, and themass storage device 2230, peripheral device(s) 2280, portable storagedevice 2240, and display system 2270 may be connected via one or moreinput/output (I/O) buses.

Mass storage device 2230, which may be implemented with a magnetic diskdrive or an optical disk drive, is a non-volatile storage device forstoring data and instructions for use by processor unit 2210. Massstorage device 2230 can store the system software for implementingembodiments of the present invention for purposes of loading thatsoftware into main memory 2220.

Portable storage device 2240 operates in conjunction with a portablenon-volatile storage medium, such as a floppy disk, compact disk orDigital video disc, to input and output data and code to and from thecomputer system 2200 of FIG. 22. The system software for implementingembodiments of the present invention may be stored on such a portablemedium and input to the computer system 2200 via the portable storagedevice 2240.

Input devices 2260 provide a portion of a user interface. Input devices2260 may include an alpha-numeric keypad, such as a keyboard, forinputting alpha-numeric and other information, or a pointing device,such as a mouse, a trackball, stylus, or cursor direction keys.Additionally, the system 2200 as shown in FIG. 22 includes outputdevices 2250. Examples of suitable output devices include speakers,printers, network interfaces, and monitors.

Display system 2270 may include a liquid crystal display (LCD) or othersuitable display device. Display system 2270 receives textual andgraphical information, and processes the information for output to thedisplay device.

Peripherals 2280 may include any type of computer support device to addadditional functionality to the computer system. For example, peripheraldevice(s) 2280 may include a modem or a router.

The components contained in the computer system 2200 of FIG. 22 arethose typically found in computer systems that may be suitable for usewith embodiments of the present invention and are intended to representa broad category of such computer components that are well known in theart. Thus, the computer system 2200 of FIG. 22 can be a personalcomputer, hand held computing device, telephone, mobile computingdevice, workstation, server, minicomputer, mainframe computer, or anyother computing device. The computer can also include different busconfigurations, networked platforms, multi-processor platforms, etc.Various operating systems can be used including Unix, Linux, Windows,Macintosh OS, Palm OS, and other suitable operating systems.

Example 1

A user receiving an intraocular eye injection can use the mobile deviceapplication to test visual function. The healthcare provider selects thevisual function tests from the list of available test on the mobiledevice application for the user based on the intraocular eye injectiontreatment. The test data can be transmitted to the remote computer andtracked between injections. Different users will respond to theinjections differently and have different periodicity betweentreatments. The test data can be analyzed to determine how the user'svision changes between treatments. The analysis can be used to predictwhen the user should receive the next injection. Tailoring the injectiontreatment to the specific user improves the efficiency of the treatmentfor the user.

The test data can also be used to detect a larger than usual decrease inthe visual function of the user and provide an alert to the user andhealthcare provider that treatment or evaluation by a healthcareprovider may be necessary.

Example 2

A user with a dry macular degeneration disease can use the mobile deviceapplication to test the user for progression to wet macular degenerationdisease. Distortion tests can be used to detect the presence of wetmacular degeneration. The healthcare provider can select a distortiontest, such as an Amsler grid, for the user. The user can take thedistortion test on the mobile device. If the results of the distortiontest indicate distortion then an alert can be generated for the user andhealthcare provider to signal the need for evaluation of the user'svisual function. The treatment programs are different between wet anddry macular degeneration diseases, thus the presence of wet maculardegeneration disease can result in a different course of treatment forthe user.

Example 3

A user receiving a recurrent treatment can use the mobile deviceapplication to test their visual function. The test data is analyzed todetermine a baseline level of performance for the user. The healthcareprovider sets a delta level for the user. If the user's test data variesfrom the baseline level of performance by more than the set delta levelthen an alert is sent to the user and the healthcare provider. The alertcan prompt the user's physician to review the visual function test datafor the user and determine whether the user should visit to thephysician's office for an evaluation. If the physician determines thatthe user should visit the physician's office a message from thephysician can be sent to the user on the user's mobile device. Themessage can prompt the user to schedule an appointment.

The foregoing detailed description of the technology herein has beenpresented for purposes of illustration and description. It is notintended to be exhaustive or to limit the technology to the precise formdisclosed. Many modifications and variations are possible in light ofthe above teaching. The described embodiments were chosen in order tobest explain the principles of the technology and its practicalapplication to thereby enable others skilled in the art to best utilizethe technology in various embodiments and with various modifications asare suited to the particular use contemplated. The present inventiondescriptions are intended to cover such alternatives, modifications, andequivalents as may be included within the spirit and scope of theinvention as defined by the appended claims and otherwise appreciated byone of ordinary skill in the art.

What is claimed is:
 1. A method for performing analysis of a visualfunction of a user with a retinal disease who is receiving recurrenttreatment from a healthcare provider, comprising: receiving the user'svisual function test data from a remote mobile device application;executing a test data analysis module stored in memory by a processor,the executed test data analysis module processing the visual functiontest data to generate a trend data of visual function and analyzing thetrend data of visual function based on the retinal disease of the userto determine the user's response to treatment, need for treatment, orneed for evaluation by a healthcare provider; transmitting the visualfunction test data and the trend data to a remote computing device; andpredicting a time for the next treatment for the user based on the trenddata of visual function.
 2. The method of claim 1, further comprising:receiving a message from a physician for the user; and transmitting themessage to the remote computing device.
 3. The method of claim 1,further comprising: transmitting the predicted time for the nexttreatment to the remote computing device.
 4. The method of claim 1,further comprising: analyzing the trend data of visual function andcomparing the trend data to previous trend data for the user.
 5. Themethod of claim 4, further comprising: transmitting an alert to theremote computing device if the trend data of visual function is outsideof a range of acceptable variation in comparison to the previous trenddata for the user.
 6. The method of claim 1, further comprising:comparing the trend data of visual function to trend data aggregated forpatients with a similar retinal disease to the user.
 7. The method ofclaim 1, further comprising making visual function test data and thetrend data available to the healthcare provider.
 8. The method of claim1, further comprising sending an alert to the healthcare provider if thechange in visual function data is above a level specified by thehealthcare provider.
 9. The method of claim 1, further comprising makingvisual function test data and the trend data available on a securewebpage.
 10. The method of claim 9, wherein the secure webpage isavailable to the user and the healthcare provider.
 11. The method ofclaim 1, wherein the visual function test data corresponds to tests thatwere pre-selected for the user by the user's healthcare provider andperformed by the user using the remote mobile device application. 12.The method of claim 11, wherein the one or more visual function testsare pre-selected by a healthcare provider based on analysis of retinalimaging of the user.
 13. The method of claim 11, wherein the test ispre-selected by the healthcare provider based on the retinal disease orthe recurrent treatment.
 14. The method of claim 13, wherein therecurrent treatment comprises monitoring disease progression oradministration of a pharmacological agent.
 15. The method of claim 1,wherein the healthcare provider is a doctor, nurse, medicalprofessional, or medical technician.
 16. The method of claim 1, whereinthe recurrent treatment includes an intraocular injection of apharmacological agent.
 17. The method of claim 16, wherein thepharmacological agent is a VEGF inhibitor.
 18. The method of claim 17,wherein the VEGF inhibitor is Lucentis or Avastin.
 19. The method ofclaim 16, wherein the pharmacological agent is Triamcinolone, Ozurdex,VEGF-TRAP, or Visudyne.
 20. The method of claim 1, wherein the retinaldisease is dry macular degeneration disease and the user's visualfunction test data includes tests that are pre-selected to determineprogression to wet macular degeneration disease.
 21. The method of claim1, wherein a frequency for performing each of the tests in the visualfunction test data are selected by the healthcare provider.
 22. Themethod of claim 21, wherein the frequency is set by the health careprovider based on the user's responses during a monitoring period ortrends in the user's visual function.
 23. The method of claim 1, whereinanalyzing the trend data of visual function includes comparing thetrends in the user's visual function to trends for other patients orgroups of other patients.
 24. The method of claim 1, wherein the visualfunction test data includes data from one or more visual function testsfrom the list: visual acuity, contrast sensitivity, low luminancevision, color vision, perimetry, and distortion in the visual field. 25.The method of claim 24, wherein a level of difficulty for a subsequentstep in the visual function test is higher than a level of difficultyfor a previous step when the user enters a correct response in theprevious step, wherein the level of difficulty for the subsequent stepis lower than the level of difficulty in the previous step when the userenters an incorrect response in the previous step.
 26. The method ofclaim 24, wherein visual acuity is measured by sequentially displayingfonts of various sizes and offering a multiple choice of fonts for amatching selection.
 27. The method of claim 24, wherein contrastsensitivity is measured by sequentially displaying fonts of variouscolors and offering a multiple choice of fonts for a matching selection.28. The method of claim 24, wherein the contrast sensitivity test beginswith a pre-selected background color and a pre-selected font color,wherein the background color or font color changes to decrease acontrast between the background color and font color.
 29. The method ofclaim 1, wherein the visual function test data corresponds to one ormore tests selected by the healthcare provider using a remote server,and transmitting the selection of the one or more tests to the user'smobile device.
 30. The method of claim 1, further comprisingautomatically re-testing the user if the visual function test data isoutside of a range of acceptable variation for the user.
 31. The methodof claim 1, wherein the retinal diseases include one or more conditionsfrom the list: macular degeneration, diabetic retinopathy, diabeticmacular edema, retinal vein occlusion, glaucoma, and chronic retinaldetachment.
 32. A system for performing a visual function analysis,comprising: a processor; a memory; a test data analysis module stored inmemory and executable by the processor to generate trend data fromvisual function test data received from a remote mobile deviceassociated with a user having a retinal disease and receiving recurrenttreatment from a healthcare provider, the test data analysis modulefurther configured to analyze the trend data from visual function testdata to determine if a next treatment is to be scheduled and predictinga time for the next treatment for the user based on the trend data; anI/O interface module stored in memory and executable by the processor tosend trend data, a predicted time for the next treatment, and aphysician message to the remote mobile device.
 33. The system of claim32, wherein the visual function test data corresponds to tests that werepre-selected for the user by the user's healthcare provider andperformed by the user using the remote mobile device.